Provider Demographics
NPI:1003277922
Name:MATSUMOTO, ALEX (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:MATSUMOTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 PAHOEHOE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1413
Mailing Address - Country:US
Mailing Address - Phone:808-284-1493
Mailing Address - Fax:
Practice Address - Street 1:915 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4544
Practice Address - Country:US
Practice Address - Phone:808-848-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD106531223G0001X
HIDT27161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice